a sad or depressed woman holds her hands over her mouth

There has been a lively debate about whether generic drugs are truly equivalent to their brand-name equivalents. That has been stirred up even further by questions about the effectiveness of certain generic medicines, including some for ADHD, epilepsy or depression.

Q. I wrote to the FDA about the side effects of generic Prozac (fluoxetine). When I take this generic antidepressant I think about suicide a lot.

I never heard back from the FDA. Apparently it couldn’t care less.

As a result I have to pay $1400 every three months for a Prozac prescription. Generic fluoxetine is about $4, but it’s not even worth that much.


Are Generic Drugs Effective?

A. You are not the first person to complain about problems with generic antidepressants. Another reader wrote,

“Two weeks ago my pharmacy switched me to a new generic fluoxetine and it’s like taking a sugar pill. All of my symptoms are back. I couldn’t even make it to work today.”

The FDA doesn’t respond to such messages. It is important to report problems, however, because the agency may investigate, especially if the manufacturer is named. The best way is online at www.FDA.gov/safety/medwatch/ or by calling (888-463-6332).

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  1. Shelly

    The generic Wellbutrin XL 300 mg is useless to me but while my insurance company says they cover this drug…they ONLY cover the generic. This should be illegal! If you cover the drug, then you should cover it. If a name brand version is mandatory, then it should be available to the insured.
    As for the once miracle of Adderall XR, once a generic was available, I was putting pet food in the refrigerator and milk in the pantry. Of course, everyone including the FDA swore that it was the very same drug. In fact, when I filled the BRAND ONLY prescription, it had the generic pills in the bottle! Another injustice! This too should be illegal! I paid the then higher co-pay for the name brand and still got the generic.
    I have no faith in our system to provide safe medicines anymore. It is all money oriented and sad to say the least.

    • JayP

      Shelly, I, too, have had a bad experience with the system not doing its job in supplying us the medications that our doctors intend for us to take. I have complained to my insurer, telling them that the monthly fight I go through to get my medications refilled makes me even sicker. For me, finding the right people to talk to has helped a lot. I started with the customer care number on my card. I eventually got connected to someone who had enough clout to make things happen on the pharmaceuticals end. I was told exactly what words were needed to be used by the doctor in an override request (to substitute the brand name for the generic) and the info needed for that. They were also helpful in providing the info on an override for a change in number of doses (for one Rx, I had been receiving pills for only 15 days a month.) and phone numbers were provided for me to have the pharmacy use if the prescription request was denied. In the end, the insurance company directed my pharmacy to refund me the difference for the prescription where I had only been given 15 pills, and everything was straightened out so that I would receive 3 month supplies for the price of two at the local pharmacy. Finally, after 2 weeks of phone calls and trips to the pharmacy, I feel like it is now straightened out to where it should have been in the first place. I am getting brand names at a higher tier, but I AM getting them–and now I’ll only be paying 2/3 as much as I was paying. MANY mistakes are made by workers who overlook important items, don’t follow up with rejected submissions to insurance, and who fill bottles with the wrong RX or the wrong dosage–or wrong dosing instructions. I am going to continue to fight to get brand name prescriptions in place of some of my other generics, so the war’s not won completely. You definitely should be getting a refund for the prescription filled with a generic when you paid the price of a name brand. I wish you success as you fight your own battles with the system.

  2. Carolyn

    I have been using Prograf successfully since 2002 for the treatment of Auto-Immune Hepatitis. I did not respond well to the long term therapy of Imuran and Prednisone before that time. In 2010 my insurance denied me coverage and wanted me to use the cheaper generic brand Tacrolimus. While on the generic drug I developed increased skin lesions on all parts of my body that grew rapidly and were suspicious. I started seeing a skin specialist on a 6-month basis to have them removed, many were biopsied. He said the lesions were caused from the Tacrolimus treatment. After one year of being on the generic drug, my Mayo Clinic doctor put me back on Brand Label Prograf and the skin lesions decreased significantly. In 2014 MedicareBlue Rx denied my Prograf again. After a letter from my doctor they reversed their decision within the same month and I was back on Prograf. Now in 2015 when I went to pick up my prescription, I was told it was denied again. I am currently at Level 3 of the Appeal Process to an Administrative Law Judge.

    I think that generic drugs should be regulated to ensure that they have the “same” ingredients as more expensive brand name drugs. It is alarming that generic drugs are not being looked at more closely. Clearly in my case something in the generic makeup was different from the brand label. MedicareBlue Rx claims that they cannot cover my Prograf drug because it is not FDA approved for the treatment of AIH. However, in the same breath they will allow me to take the “cheaper” generic drug Tracrolimus. As far as I know, the FDA regulates “FDA approved drugs.” It does not regular generic, as the generic are supposedly the “same” as brand name. But is the generic really the same?

  3. Brad
    Portland, OR

    As a pharmacist, I agree that all generics (and brands) do not act the same in all patients. The FDA allows a range in their testing. Many patients tolerate one generic very well and then have problems with a different one. Insurance plans often allow trying other generics or maybe even the brand product if their primary contracted generic product does not work as expected for the patient. It might take an appeal to the plan to be approved.

    In this case, I would recommend the patient consider discussing if another antidepressant would be worth trying. Almost all of the most commonly used antidepressants are inexpensive because their patents have expired so they are available in generic form. I know many patients and friends that have not tolerated one antidepressant and responded very well to another.

  4. Martha

    I was on toprol and was switched to generic. They had to raise my dose from 50 to 100. I told them I wanted back on toprol. It cost more but I don’t have to take as much.

  5. Angie
    St. Louis, MO.

    I was on 450 mg Wellbutrin XL. I couldn’t afford the brand name and started taking a generic. Everything was ok until the pharmacy switched to the manufacturer Actavis. Within a week, I couldn’t work and became very suicidal. My psychiatrist asked what manufacturer it was and I told him, he said he had several other clients who deteriorated from it as well. Now I have to get approval from my insurance company every year to get the brand name Wellbutrin XL. I hate generics and will try to get brand name medicine whenever possible.

  6. Sarah D.
    Charleston SC

    I have A-Fib, and Toprol XL worked beautifully. Generic Metoprolol left me with frequent episodes. (ie: 7 vs 2 or 3)

    Valium has been very effective for 60 yrs. The generic turned me into a zombie. People asked me if I was OK?!!

    Ambien is very effective, but the generic basically doesn’t work or I have to take twice as much.

  7. Heather

    NO absolutely NO generic drugs do not work. Fillers are cheap and nasty. They are not long lasting either. I took a generic in hospital within 4 hours had an asthma attack. Never generics again. Made in India mostly to NO standards no checking. FDA just believe the drug companies telling the truth.

    Generics NOT cost effective as they cause more adverse events and hospitalisations.

  8. Shirley F

    I like to read your column as I have gotten lots of helpful remedies from it. Thanks

  9. Anne

    Prozac was the same for me in that it worked great until I was put on generic. Then, I might as well have been taking nothing. I guess the upside for me is I managed to deal with my depression through additional therapy and time.

  10. Jim

    since depression and other emotional disorders are often variable in that the symptoms wax and wane and the diagnosis is somewhat subjective as to the severity. As I understand it many experts feel cognitive therapy is as good if not better than antidepressants in non major depressive disease.

    I have heard of epileptics losing control on brand name Dilantin.

    Does not Dilantin and other drugs used for epilepsy have a lot of drug interactions? The political question remains this: if we keep cutting the size of the federal government, do we expect the FDA to fulfill all the missions required by congress?

    • The People's Pharmacy

      You are right that many anticonvulsant medicines have potential interactions.

      Your political question is worth pondering.

  11. Pharmabuse

    Can’t help but think that at least some of the fuss about generic drugs is a red herring concocted by brand name drug manufacturers whose patents have expired, and are looking to get one more egg out of the golden goose. As for suicidal ideation, it’s a known side effect of Prozac (fluoxetine). One only need look at the black box warning, or the Treatment of Adolescents with Depression Study (TADS). During the TADS, 17 out of 18 suicide attempts were carried out by subjects who had taken fluoxetine.

  12. Lizzie
    United States

    I have seen recent comments on the effectiveness of CPAP therapy in heart patients. I’ve used one for years but still find it a bother although I seem to sleep better and have not had a cold since I started using it about 7 years ago. What do you think?

  13. Debbie

    I have the same problem but I take Wellbutrin XL 300
    Generic did not work, made me worst. Same thing on my high blood pressure medicines, my blood pressure did not come down but instead spiked at times. Generic medications are a joke. They need to lower price of Name Brand medicines to be more affordable for people who cannot take Generic medicine.

  14. Marcelle
    Boston, MA

    I was forced to change to generic on a medication I use when Prevacid had a generic come out. It made me so sick, I ended up at the emergency room. The manufacturer, I was told by a endocrinologist is notorious for its fillers and it is the fillers that make people sick or does not make the medication effective in my opinion and experience.

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